Auditory toxicity in late preterm and term neonates with severe jaundice.
Sanjiv B Amin, Satish Saluja, Arvind Saili and 4 others
PMID 27718221WHAT IT FOUND
Unbound bilirubin was more strongly linked to auditory toxicity than total bilirubin in 100 late preterm and term neonates with severe jaundice, especially below 25mg/dL.
Total bilirubin alone did not identify every infant with auditory toxicity.
Key findings
01Twenty-eight of 100 neonates had auditory toxicity, including 15 with auditory neuropathy spectrum disorder and 13 with elevated auditory brainstem response threshold.
02In regression models adjusted for mode of delivery, sepsis, and exchange transfusion, peak unbound bilirubin and BAMR were significantly associated with auditory toxicity, but peak total bilirubin was not.
03Among 69 neonates with severe hyperbilirubinemia, 11 (16%) had auditory toxicity, and peak unbound bilirubin was significantly associated with auditory toxicity while peak total bilirubin and BAMR were not.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a prospective cohort, not a randomised trial, so it cannot prove that unbound bilirubin caused auditory toxicity or that acting on it improves outcomes. The auditory evaluation was done after resolution of jaundice and within 96 hours of peak total bilirubin, so it cannot show what happened earlier or whether findings persisted. The study included only neonates of 34 weeks' gestational age or more with severe jaundice, and excluded children with craniofacial malformations, chromosomal disorders, family history of congenital deafness, certain infections, surgical interventions, failed hearing screening before jaundice, or parents outside Delhi, so results may not apply to more premature infants or other settings. The authors state they were unable to evaluate the role of clinical risk factors in bilirubin-induced auditory toxicity. The subgroup analyses were based on 69 neonates with severe hyperbilirubinemia and 31 neonates with extreme hyperbilirubinemia, so subgroup findings may be less stable than the main analysis.
Declared interests
The supplied text does not report author conflicts of interest. The publication types list non-U.S. government and NIH extramural research support.
The easy way to misread this
Do not conclude that unbound bilirubin should replace total bilirubin in clinical decisions. The study shows an association and better prediction of auditory toxicity, not that using unbound bilirubin changes treatment or prevents hearing loss.